【摘要】连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)主要原理是利用超滤作用清除体内过多的水分，以对流方式清除中、小分子溶质，利用吸附清除炎症介质。在临床应用中，不断衍生出各种治疗模式：连续性静静脉血液滤过(continuous venous-venous hemofiltration, CVVH）、连续性静静脉血液透析滤过(continuous venous-venous hemodiafiltration,CVVHDF)、高容量血液滤过(high- volume hemofiltration,HVHF)、连续性血浆滤过吸附(continuous plasma filtration adsorption, CPFA)、缓慢连续性超滤(slow continuous ultrafiltration,SCUF)、持续低流量血液透析(sustained lowefficiency dialysis,SLED)等等。CVVH 是临床最常用的治疗模式，常用于顽固性心力衰竭、重症急性胰腺炎、横纹肌溶解等的辅助治疗；CVVHDF 近年广泛应用于脓毒血症的治疗,HVHF 常用于重症脓毒血症、感染性休克的患者；CPFA 可用于重度炎症反应综合征和脓毒血症；SCUF 常用于难治性心力衰竭、水肿，细胞外液容量高负荷者。目前常用的CRRT 技术各有其自身特点，可根据病情需要个体化合理选择治疗模式和治疗剂量。
【Abstract】Continuous renal replacement therapy (CRRT) has the roles of ultrafiltration to remove excess water, convection to clear medium and small molecular solutes, and adsorption to eliminate inflammatory mediators. The therapeutic models of CRRT are developed progressively, such as continuous venous-venous hemofiltration (CVVH), continuous venous- venous hemodiafiltration (CVVHDF), high- volume hemofiltration (HVHF), continuous plasma filtration adsorption (CPFA), and slow continuous ultrafiltration (SCUF). CVVH is the most commonly used model, usually as an adjuvant method for refractory heart failure, severe acute pancreatitis, rhabdomyolysis, and many others; CVVHDF has been widely used for the treatment of sepsis;
HVHF is a treatment often for severe sepsis and septic shock; CPFA can be used in severe inflammatory response syndrome and sepsis; SCUF is often used in patients with refractory heart failure, edema, and overload of extracellular fluid volume. Every CRRT technology has its own characteristics, and the selection of therapeutic model and dosage must be individualized based on clinical situation of the patient.
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